From the Guidelines
Surgical debridement is indicated for a plantar ulcer when non-surgical offloading treatment fails.
Indications for Surgical Debridement
- Failed non-surgical offloading treatment: Surgical offloading interventions, such as Achilles tendon lengthening, metatarsal head resection, joint arthroplasty, or osteotomy, should be considered for patients with diabetes and a neuropathic plantar ulcer who have failed non-surgical offloading treatment 1.
- High-risk patients: Surgical offloading interventions may be considered for high-risk patients with diabetes and a plantar forefoot ulcer who have failed conservative treatment 1.
Important Considerations
- Risk of complications: Surgical offloading interventions potentially come with increased risk of complications, such as new rearfoot ulcers, falls, and infections 1.
- Combination with offloading devices: Surgical offloading interventions should be used in combination with an offloading device to promote and sustain healing of the ulcer 1.
- Patient selection: The decision to use surgical offloading interventions should be based on individual patient assessment, taking into account the patient's overall health, the presence of any contraindications, and the potential benefits and risks of the procedure 1.
From the Research
Indications for Surgical Debridement
Surgical debridement is indicated for plantar ulcers in the following situations:
- Infected ulcers with osteomyelitis, where debridement is necessary to remove infected bone and tissue 2, 3
- Chronic, nonhealing ulcers that have not responded to conservative treatment, where surgical debridement can encourage healing by converting a chronic nonhealing wound environment into a more responsive acute healing environment 4, 5
- Ulcers with significant necrotic or devitalized tissue, where debridement is necessary to promote healing 4
Specific Conditions
Surgical debridement may be particularly beneficial in the following conditions:
- Diabetic foot ulcers, where surgical debridement has been shown to be effective in promoting healing and preventing amputation 2, 5, 3
- Neuropathic plantar forefoot ulcers, where surgery has been shown to be superior to nonsurgical treatment in terms of healing rate and recurrence rate 5
Considerations
When considering surgical debridement for a plantar ulcer, the following factors should be taken into account:
- The presence of critical limb ischemia, which may need to be addressed before surgical debridement can be performed 2
- The potential for complications, such as dehiscence of the surgical site, bone cement dislocation, and recurrence of the ulcer 2, 3
- The need for off-loading and other conservative measures to promote healing and prevent recurrence 6